Aetna Sets Add-on Fees For Viagra Coverage

Prudential Cites Safety In Refusing Coverage

Employers who want Aetna U.S. Healthcare to pay for the impotence drug Viagra could spend $18.84 to $70.80 per worker more a year in premiums, company documents show.

Aetna also is moving to formally exclude Viagra from its basic prescription plans, along with any ``lifestyle enhancement'' drugs that the company concludes are not medically necessary.

In related news, Prudential HealthCare said Thursday that, because of safety concerns, it will not cover Viagra.

Aetna has said it will not cover Viagra in its regular prescription plans, but only through a special rider at additional cost.

Connecticut insurance regulators recently approved the new rider, which covers Viagra and three other drugs for erectile dysfunction, and the rates. Premiums vary by the number of pills an employer is willing to pay for, ranging from six to 12 every 34 days.

Premiums will also depend on the size of the co-pay that an employer wants members to be charged each time they fill a prescription for impotence drugs, ranging from nothing to $30, or 50 percent of the cost.

An employer with 100 workers, for example, would pay $1,884 extra in premiums a year for insurance that will cover up to six Viagra pills every 34 days, with an employee paying half the prescription cost.

For the most comprehensive Viagra coverage, it would cost the same employer $7,080 a year for Aetna to cover up to 12 pills every 34 days, without charging members a co-pay.

The rates are based on the size of the entire insured work force, not just the number of men.

Aetna is offering the Viagra rider to employers of 50 or more workers.

The company is also amending its regular prescription drug plans to specifically exclude impotence drugs and ``performance, athletic performance or lifestyle enhancement drugs and supplies.'' The amendment does not define what those drugs are, and Jill Griffiths, an Aetna U.S. Healthcare spokeswoman, was unable to provide a definition Thursday.

Insurers' use of the term ``lifestyle drug'' is increasingly stirring debate because it often refers to drugs that some people believe should be covered, though health plans consider them medically unnecessary. Viagra and birth control pills are among them.

Officials at the state Department of Insurance said they approved Aetna's lifestyle drug exclusion without asking the company to explain what it means.

``I don't think it's our responsibility to say to them, `What does every word in the exclusion mean,' '' especially when prescription coverage is not mandated in Connecticut and state laws do not specify what should or should not be included, said Austin M. Soares, associate examiner in the department's life and health division.

It is a matter for discussion between employers and insurers, and, without statutory guidance, ``we have to let the market roll as it will,'' Soares said.

New York's Department of Insurance, however, has not yet approved Aetna's Viagra rider or exclusion and is ``taking a critical look'' at the wording and the policy issues it raises, said John Calagna, a department spokesman.

Meanwhile, Prudential said it will not cover Viagra and is not proposing an optional rider to do so, citing recent reports of deaths among men taking Viagra. Officials of Pfizer, which makes the drug, could not be reached for comment Thursday.

``Cost did not drive this decision,'' said Kevin Heine, a Prudential spokesman. Other insurers, including Aetna and Kaiser Permanente, have cited cost as a major factor in refusing to cover Viagra under basic prescription plans.

The Food and Drug Administration is investigating deaths and adverse reactions of men who took Viagra.

Prudential's chief medical officer, Dr. Anthony Kotin, said his company is also concerned about the risk to patients who recently had a heart attack or stroke and then take Viagra. Such people were excluded from the published clinical study released by Pfizer, he said.

``We think it would be irresponsible,'' Kotin said, ``to cover the drug without answers to why those adverse situations occurred.''